Questions About Fm/im

[shogun91]

Hello all,

 

I'm currently in my third year of an American MD school with an interest in coming back to Canada for residency. I had some questions about how family and internal worked in Canada as I'm only exposed to the U.S. system through my rotations.

 

1. Are hospitalists primarily FM or IM? If it is a mixture, it there a difference is salary potential?

 

2. In the U.S. there has been significant encroachment on FM territory by NP's and PA's. What is more concerning is they keep fighting for even more scope in their practice. What do you guys think? Is there a concern for this in Canada, affecting FM moving forward?

 

3. What is the role of IM in Canadian hospitals? In the U.S. IM runs general floors (including specialty floors and ICU), handle admits, rounds, discharges etc. I've heard that even general IM is more of a consult service in Canada for higher acuity patients. Clarification would be wonderful.

 

Thank you everyone and thanks in advance!

[ralk]

1. The term "hospitalist" in Canada usually refers to FM physicians, though IM physicians are doing much of the work of what the US considers "hospitalist" work in Canada. The difference is usually in acuity and location, with IM physicians taking care of higher acuity patients in major city centres, while FM physicians will take care of patients in rural hospitals or on wards with lower acuity. For example, the hospital I did most of my training had patients requiring a hospital stay admitted to a ward covered by the Internal Medicine team, but could be stepped down to a ward covered by an FM physician if they had their basic management plan settled and simply required longer in hospital.

 

2. There's too much demand for primary care providers in general, as well as not enough NPs/PAs to be much of a threat to FMs. Both groups face funding difficulties, as they cannot simply set up shop and offer their services. Some NP-run primary practices have been set up with government funding, but they're relatively uncommon, especially outside of underserviced communities. Family health teams can also employ NPs, but these are still physician-run centres. Many NPs work in hospitals these days with specialists, as these departments have funding to pay their salaries. PAs have no independent practice rights and are basically reliant on physicians to do anything, unlike NPs who can do things on their own if they have a funding source. I'm going into FM and not worried about either.

 

3. IM runs inpatient floors (general or subspecialty, though usually subspecialty floors are covered by subspecialists). ICU is increasingly handled by dedicated critical care physicians (who can be IM physicians by original training, but may be from other specialties as well). Smaller centres can rely on general IM docs to cover their ICU, particularly overnight. General IM does do consults for other hospital services, and the hospitals I trained at had dedicated medicine consult teams for that purpose. 

[LittleDaisy]

Ralk, what are we going to do without your detailed replies??

Hope that you will be staying in the forum for a long time

[ralk]

Ralk, what are we going to do without your detailed replies??

Hope that you will be staying in the forum for a long time

 

My school's 4th year winter schedule is pretty light and I'm kinda bored right now, hence the longer posts 

[LittleDaisy]

Ahahahah well at least we could say that you are a balanced medical student, having the time to help others, while doing CaRMS

Strengths: Altruism, empathy and adapt well under stress

Thanks for your detailed posts, and good luck to all us for CaRMS

My school's 4th year winter schedule is pretty light and I'm kinda bored right now, hence the longer posts 

[shogun91]

Awesome, thanks ralk!